Kin-Keepers Shoulder Growing Load Between the Generations

She was in a master’s degree program at the University of Maryland when her parents died. Then her in-laws, who were in their 90s and living in another city, had to move out of their apartment and into a more controlled environment.

“This was a student in her mid-50s, and she had no income,” says Prof. Nancy Schlossberg. “Her husband was earning the salary. So who goes up to help the elderly in-laws?”

At the same time, her daughter finished college and moved home; and her son, who was married and had a child, was laid off from his job.

“It was like a ripple effect, with one transition and another and another,” says Schlossberg, professor in the department of counseling and services at the University of Maryland’s College of Education. “The person who got the brunt of all this was the middle-aged kin-keeper. There was no way she could stay in the master’s program.”

Care for the Elderly

While Schlossberg’s student’s precise situation may have been unique, the quandary in which she found herself is not: As the graying of America continues at a rapid pace--with the majority of the elderly leading active and healthy lives to the end--significant numbers require some form of care.

Contrary to popular belief, the major portion of that care comes from other family members. “It is a myth,” says sociologist Roberta Greene, “that government or other sources of help are the major providers of assistance to older people and their families: 80% of the care older people receive usually is from a family member. The other 20% may be getting a variety of care, ranging from being rather healthy and going to senior centers for activities and meals, to actually needing very intensive health-care services in the community or a nursing home.”

The important news, Schlossberg stresses, is that most people still are not institutionalized when they need intensive health care. “Families care for each other,” she says, “but the real issue is who does the caring, and who that is is the women: the daughters and daughters-in-law. They are the ministers of the interior . . . the kin-keepers.”

Responsibilities to Kin

Schlossberg points out that nearly half of all women aged 40 to 60 are in the labor force, with more and more beginning or resuming careers every year. Four of 10 women in that bracket have child-care responsibilities, and one in 10 have responsibilities toward older relatives.

“That,” says Schlossberg, “is the double dependency, where you’re caring for generations on either side of you. That’s what produces terms like ‘the caught-in-between generation,’ ‘the sandwich generation.’ ”

Schlossberg’s middle-aged student eventually earned her degree, but not until she got her in-laws settled and helped her children sort out their lives.

These primary care-givers often pay a price for their efforts, says Greene, staff director for family practice of the National Assn. of Social Workers. Such costs may range “from mild to severe emotional strains from the effects of not having recreation, not getting out sufficiently, not having privacy, all the way to severe depression.”

Problems can be exacerbated, says social worker Barbara Silverstone, executive director of the New York Assn. for the Blind, if aging parents are viewed as dependent and childlike, a notion suggesting that the adult child take on the role of the parent while the aging parent becomes the child.

Role Reversals

“When adult children try to see themselves in the parent role,” says Silverstone, “the emotional somersault involved can result in negative feelings--anxiety, resentment, anger and guilt.”

Among her suggestions for handling negative feelings:

Let your aged parent know how you feel. Most aging parents, no matter how ill, are concerned about the well-being of their sons and daughters.

Improve communication among all members of the family. Poor communications can be a source of bad feelings, only exacerbating an already difficult situation.

Meet with other care-givers or with self-help groups. The realization that others suffer the same burdens and harbor similar feelings is very supportive, and places these feelings in a healthy perspective.

Accept your own human limitations in a busy life with other priorities. Seeking respite from the day-to-day, care-giving situation and gaining control over our lives is critical to a sense of well-being.

Such respite could range from putting the aged parent in a formal senior day-care program to something as simple as enlisting a neighbor or other family member’s help--”Will you come in for an hour? I have to get out for a while.”

Care for Caretaker

It’s a matter, says Greene, “simply of not letting things build to the point where the person is so tense or exhausted that they themselves experience difficulty.”

Matters can be further complicated where there is an wide array of family responsibilities. “You may have people within the family group,” notes Greene, “at all stages of activity, needs and inputs--maybe four generations at the same time, plus the family’s financial situation.”

Even when the family has the resources required for outside help, the appropriate backup services may not be available in the community.

Another problem with the situation of older children caring for aged parents, says Schlossberg, is “We don’t have any guidelines. It’s really new. You’re having to develop your own map. Once you are caring for aging parents, it’s really unpredictable. You don’t know how long it’s going to last.

“There is a potential situation of caring for those aging parents that might never occur, and when it does occur there is tremendous ambiguity. We don’t know what’s right to do, we don’t have any norms or standards for what is or is not appropriate behavior.”

Guidelines for Coping

Each person caring for aging parents has a different set of circumstances, notes Schlossberg, and she has developed a framework to help individuals assess and deal with their particular predicament:

The situation: Focusing on exactly what is going on in your particular family.

The supports available to you: Within your immediate family, in your neighborhood and community.

Strategy: How you actually are going to handle the day-to-day and long-term requirements you have identified.

Greene voices optimism about the basic strength of the American family to cope successfully:

“Families,” she says, “tend to develop patterns over the years, because this isn’t the first transition they’re facing together. Those patterns that they bring to this stage are sufficiently strong that they enable them to continue coping with sometimes quite serious illnesses, like where we hear about the ‘36-hour day’ with the Alzheimer’s disease patient.”

Employers Taking Note

Also, she says, there is evidence that corporate America is taking note, “becoming more aware that just as women may need some opportunity for day care (for their children) that they may need a certain number of days in a year for elder care.”